As sudden deaths show, no amount of cocaine is recreationally safe, Health Science Center cardiologists note in editorial

SAN ANTONIO (Jan. 13, 2010) — A study of sudden deaths in young Spaniards who used cocaine, published today (Wednesday, Jan. 13) in the European Heart Journal, underscores the devastating effects of the drug on the cardiovascular system and dispels the notion that its recreational use is safe, even in the smallest amounts.

Those are the conclusions of cardiologists Richard A. Lange, M.D., and L. David Hillis, M.D., of The University of Texas Health Science Center at San Antonio School of Medicine, who wrote an editorial on the study for the journal.

The study in southwestern Spain examined a consecutive series of 686 sudden deaths in the Seville region over a 32-month period. The researchers studied blood and urine samples and conducted pathologic studies at post-mortem to assess the prevalence and causes of cocaine-related fatalities. “As such, their study is one of the larger and more extensively characterized analyses of drug-related sudden death in Europe,” Drs. Lange and Hillis wrote.

Of the deaths 21 were cocaine-related, and all of these were in men aged 21 to 45 years. An estimated 7 percent of people in Spain admit to using cocaine at least once. Lifetime prevalence in the United States is estimated to be greater than 14 percent. One of the contributing factors is “the misperception that recreational cocaine use is safe,” the editorialists wrote.

Drs. Lange and Hillis outlined several deleterious cardiac effects of cocaine use, including angina pectoris (chest pain), myocardial infarction (heart attack/arrest), and cardiomyopathy (thickening of the heart walls). They note that other studies have shown that most individuals with cocaine-related cardiac disease have few, if any, risk factors for heart disease.

“In such otherwise ‘low-risk’ subjects, investigators have reported that the risk of myocardial infarction is increased approximately 24-fold over baseline in the 60 minutes after cocaine use,” they wrote.

The Spanish study’s post-mortem analyses found a large range of blood serum cocaine concentrations in individuals who died following cocaine use. “This suggests that no blood concentration is always safe,” Drs. Lange and Hillis said.

Also, nearly half of cocaine-related sudden deaths occurred on weekends, suggesting, the cardiologists said, that these deaths likely were related to recreational use rather than chronic, daily use.

They also wrote that, likely, the prevalence of cocaine and other illicit drug use is underestimated.

“Physicians should consider the possibility of cocaine abuse in a young individual with cardiovascular disease or sudden death, especially in those without traditional risk factors for atherosclerosis,” Drs. Lange and Hillis concluded. “Finally, the notion that recreational cocaine use is ‘safe’ should be dispelled, since even small amounts may have catastrophic consequences, including sudden death.”

Note: Dr. Hillis occupies the Dan F. Parman Distinguished Chair in Medicine and is chairman of the Department of Medicine in the Health Science Center School of Medicine. Dr. Lange is professor and executive vice chairman of medicine and director of the office of educational programs in the Department of Medicine.

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